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Early Childhood Caries (ECC) –Chronic, infectious disease among children aged 0-5 Most common disease of childhood 5x more common disease than asthma –Transmitted through saliva-sharing behaviors –California 33% of preschool aged children ~70% in Kindergarten through grade 3 – 5

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Fluoride Recommended for Young Children CDC, American Academy of Family Physicians & Pediatrics, American Dental Association Frequent exposure to small amounts of fluoride in all age groups reduces tooth decay Brushing twice daily Drinking fluoridated tap water High-risk groups → additional fluoride may be needed Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States, CDC Web site at:

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15 Where do we get fluoride? –T–Toothpaste –F–Fluoridated tap water -- Fluoride Varnish Parents at home Dentist’s or Physician’s office

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FV is an Effective & Accepted Treatment for Children FV is shown to be safe and prevent ECC with one or more applications/ year. –Weintraub JA et al. J Dent Res states reimburse (Medi-caid) for FV in US.

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19 Efficacy of FV for ECC Prevention % Children with Caries Incidence at Last Follow-Up Exam by Treatment Arm (n=280) Weintraub, et al. JDR, 2006 CAN DO 1

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Benefits of Fluoride Varnish Safe for children Strengthens teeth to prevent cavities Doesn’t hurt child when being applied Easy and fast to apply with single application Temporary: stays on teeth for 4-6 hours Does not replace brushing with toothpaste, drinking tap water, or taking supplements! 20

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Safety of FV No documented incidents of acute or chronic fluoride toxicity FV’s rapid drying characteristics prevents ingestion and minimizes risk of toxicity –takes several days to break down so ingestion occurs slowly reducing risk of acute fluoride toxicity Release of fluoride peaks early and drops dramatically Plasma levels of fluoride after application are similar to fluoride toothpaste usage 21 Assoc of State and Territorial Dental Directors Fluorides Committee. FV: an Evidence-based approach 2007.

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Contra Costa Regional Medical Center FV Policy Adopted February 2010 – Policy 4085 Purpose: provide guidelines for FV application to prevent dental caries and other oral health problems Children from 12 months through 5 years of age will receive FV in the clinic at well child visits.

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How to Discuss Fluoride Varnish with Parents 1. Say: “To reduce the risk of tooth decay, we are going to apply FV to your child’s teeth today.” 2. Ask: “Do you have any questions?”

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Cooperative Child: Knee to Knee and FV application

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Infant FV application video 26

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After Application Reminders DO OK to drink water Soft foods only Resume brushing teeth and flossing next morning Remember that yellowish/ whitish coating will go away DON’T Avoid food for 20 minutes Don’t give foods that are hot, hard, crunchy, chewy, or spicy for the rest of the day Stop fluoride supplements for 3-5 days after application 27

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Provider Responsibilities Educate parents –baby teeth are important and children need to see a dentist by age 1 Conduct Oral Exam –Screen for ECC and dental emergencies –Document findings or problems Recommend FV to parents Order FV application –Well child form 28